Define 3 stages of labor

1st stage - onset until full cervical dilation A. latent - cervix effaces (thins) until dilation of 6 cm - can be up to 20 hours in nulli, 14 hrs in multip* if prolonged - NOT an indication for C-section, give pitocin

1. Risk factors - placenta implanted in fundus, placenta accreta

3. What to do if it happens - fluid resuscitation - reduce the uterus - if initial attempt is unsuccessful, use relaxation agents (halothane, terbutaline, mag sulfate) then try again to reduce the uterus- then give uterotonic agents (e.g. oxytocin) to prevent it from coming out again - if unsuccessful, laparotomy

3. Mgmt - give Rhogam if mom is Rh (-), use Kleihauer - Betke test to see how many fetal nucleated RBCs are to dose the rhogam- threatened (normal pregnancy with bleeding) - pelvic rest - incomplete, inevitable, missed - medical (misoprostol) or surgical (D and C or Dand E or inducing labor with pitocin and PGEs) *need to r/o preterm labor and incompetent cervix in second trimester since they can lead to abortions

3. Mgmt - IV gentamicin and clindamycin until pt afebrile >24 hours; add amp if GBS infection, infection persists - if fever does not improve after 2-3 days --> do CT to r/o abscess, infected hematoma, or septic pelvic thrombophlebitis- if fever is due to wound infection --> open wound